Educational Opportunity Program (EOP) 1801 E. Cotati Avenue, Rohnert Park, CA 94928 Supplemental Application Form Name __________________________________________ SSU ID __________________________________________ Date_________________________ Dear EOP Applicant, We have received your EOP application but we need further details and/or information from you before we can complete you EOP Application process. Please complete this form and email the form back to us as soon as possible. Not doing so will prevent your application from being completed. The purpose of this form is to gather information that will help us make an accurate assessment on your eligibility for EOP. 1. Higher Education Have both or one of your Parent/Guardian(s) graduated with or obtained an equivalency of a U.S. 4‐year university degree in a foreign country outside the USA? YES☐ NO☐ If yes, what country? 2. Historical Household Income Over the past 10 years, what has been the yearly income of your Parents/Guardians? If they are divorced and/or separated, list the years they were together and the years that 1 or both supported you in the corresponding columns. If their income amount was ‘0’ for a year, put down 0 for dollar amount. If you cannot provide income figures for all 10 years, please describe the economic situation of your family while you were growing up. To view CSU minimum income levels, go online to https://secure.csumentor.edu/planning/eop/income.asp Please check the most appropriate box that describes your family income history and provide the Parental Guardian income figures. The amounts do not have to be exact; they can be an estimation or ‘gestimate’ for each year. HOUSEHOLD SIZE For the purposes of counting, a Household Size is considered all those persons living and being supported by the head of the home. This figure should reflect the amount reported on the IRS Tax Return forms. ☐ BOTH PARENTS (Combined income) ☐ A SINGLE PARENT Separated☐ Divorced☐ Non‐married head of household ☐ INDEPENDENT STATUS Emancipated, Foster Youth, A Ward of the Court Father☐ Mother☐ Other☐ Household Income Size Household Income Size 2013 $_______________ _____ 2012 $_______________ _____ 2011 $_______________ _____ 2010 $_______________ _____ 2009 $_______________ _____ 2008 $_______________ _____ 2007 $_______________ _____ 2006 $_______________ _____ 2005 $_______________ _____ 2004 $_______________ _____ 2013 $_______________ _____ 2012 $_______________ _____ 2011 $_______________ _____ 2010 $_______________ _____ 2009 $_______________ _____ 2008 $_______________ _____ 2007 $_______________ _____ 2006 $_______________ _____ 2005 $_______________ _____ 2004 $_______________ _____ Household Income Size 2013 $_______________ _____ 2012 $_______________ _____ 2011 $_______________ _____ 2010 $_______________ _____ 2009 $_______________ _____ 2008 $_______________ _____ 2007 $_______________ _____ 2006 $_______________ _____ 2005 $_______________ _____ 2004 $_______________ _____ 3. Do your Parents/Guardians own Property ☐ (other than house or unit currently living in) Rental Units ☐ Farm ☐ Business☐ Stocks ☐ Other Investments ☐ If yes, what is the estimated value? $ Please explain the circumstances: 4. Level of Interest for Sonoma State 1st Choice campus ☐ 2nd Choice Campus ☐ Some interest ☐ Where ever I can get in ☐ Don’t really know ☐ Please briefly tell us why you want to come to SSU and why you are applying to the EOP Program. Do you think you are mentally and academically prepared for college? ____________________________________________________________________________________________________________________________________ If you have questions regarding any part of this Supplemental EOP Form, contact Luis Vega at Sonoma State University at 707‐664‐3437 or [email protected].
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